I agree Rachael.
I bring up this issue in relation to adoptive mums. Yes, low milk supply can
be an issue for adoptive mothers. It's a significant risk factor. Is it
possible to tell which mothers will have low supply? No, it's not. Should
women be told that they will not make enough milk. Absolutely not! (though
many are told this by people with the right initials!)

I look at it this way. Perceived insufficient milk supply is the number 1
reason for early weaning world wide. For eg 30% or so of women in Australia
nominate not enough milk as the reason for weaning. Now, for most of these
women you would assume that they were physical capable of making enough milk
but were either attempting to breastfeed in a way not compatible with making
sufficient milk, had undiagnosed issues such as poor attachment or were
misinterpreting their baby's behaviour. Regardless of the reasons PIMS is
extremely common. My question is, why single out a particular group of women
who have conditions that *may* result in low milk supply when a large slab
of the population are going to wean because they feel they have low milk
supply. Does it matter why they feel they have PIMS? Why not tell all women
that there is a 1 in 3 chance that they will wean because of low milk
supply, that they will feel they do not have enough milk? Why don't we do
that? Because as Rachael said, confidence is important! Suggesting to women
that they may not make enough milk becomes a self fulfilling prophecy. So,
what to do. IMO it's a case of give support, give mums (all mums!) the best
chance of being able to successfully breastfeed by good births, good
information and lots of encouragement. Get them hooked into peer
breastfeeding support (there's one very old study that found that women who
are involved in peer bf support organisations report PIMS at 1/10 the rate
of women in the general population and certainly in my study of long-term
breastfeeding I found that although the women reported an encyclopedia worth
of breastfeeding challenges low milk supply was quite rare....many of these
women were members of ABA). IF there are problems, then that's the time to
explore what the potential cause might be....and of course what I say about
adoptive breastfeeding applies to all women with insufficient milk supply. A
mum who has low milk supply has every chance of being able to fully
breastfeed, she just needs to breastfeed for long enough...it might be one
week, one month or one year before she dispenses with supplementation but it
can nearly always happen eventually.
Karleen Gribble
Australia



----- Original Message ----- 
From: "Rachel Myr" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, July 17, 2007 9:50 PM
Subject: Risk and predicting the future


> The question was asked how to discuss the risk of insufficient milk with a
> pregnant woman who has some risk factors for low supply.
>
> As with diagnostic tests, if the issue in question is worth mentioning, it
> should have some bearing on how you will proceed in providing support and
> guidance to the woman.  I can't see how my handling of such a mother and
her
> baby would be any different given that I know that some women with
> polycystic ovaries or hypothyroidism or just overweight develop milk
supply
> problems, and the vast majority, in my experience, do just fine.
Therefore
> I would be unlikely to bring it up at all antenatally unless specifically
> asked by the woman, in which case I would tell her the truth: that nobody
> knows until the baby is born, how it will go, but we know what we can do
to
> maximize the odds of success.  That is, of course, to follow the ten steps
> to successful breastfeeding.
>
> All mothers and babies deserve to have easy access to people who are
> competent to help them fix problems that may arise with the establishment
or
> maintenance of breastfeeding.  Mothers with so-called risk factors deserve
> no less, but no more, either.  Any woman who gets bad care can wind up
> struggling with iatrogenic problems, no matter how perfect her health or
her
> motivation or even her birth.  I would hate to see any of those problems
> chalked up to her thyroid gland, or her adiposity, or anything else about
> her personally.
>
> Breastfeeding is like giving birth in the sense that you need all the
> self-confidence you can muster, and then some.  I am so short that if I
had
> had my first baby in Norway I would have been sent for x-ray pelvimetry,
> while being told I would be allowed to go into labor and 'see how it
goes'.
> How's that for doublespeak?  I'm very happy that I was not subject to
> anything so undermining, but was instead surrounded by caregivers who had
> every expectation that my body would work, and we all knew that if it
> didn't, they and I would be able to figure out what to do about it.  A
> discussion of risk would have been entirely superfluous.
>
> Rachel Myr
> Kristiansand, Norway
>
>              ***********************************************
>
> Archives: http://community.lsoft.com/archives/LACTNET.html
> Mail all commands to [log in to unmask]
> To temporarily stop your subscription: set lactnet nomail
> To start it again: set lactnet mail (or
[log in to unmask])
> To unsubscribe: unsubscribe lactnet or
([log in to unmask])
> To reach list owners: [log in to unmask]
>

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
Mail all commands to [log in to unmask]
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or [log in to unmask])
To unsubscribe: unsubscribe lactnet or ([log in to unmask])
To reach list owners: [log in to unmask]